Early Detection of First-Episode Psychosis: The Effect on 1-Year Outcome

• DOI: 10.1093/schbul/sbl005
• Publication Date: 2006-06-30T10:36:57Z
• Authors: T. K. Larsen; I. Melle; B. Auestad; S. Friis; U. Haahr; J. O. Johannessen; S. Opjordsmoen; B. R. Rund; E. Simonsen; P. Vaglum; T. McGlashan
• Keywords: Adult; Male; Mental Health Services; Adolescent; Norway; Middle Aged; Outcome and Process Assessment (Health Care); Combined Modality Therapy; 3. Good health; Psychotherapy; 03 medical and health sciences; Early Diagnosis; Outcome and Process Assessment, Health Care; 0302 clinical medicine; Psychotic Disorders; Schizophrenia; Humans; Female; Schizophrenic Psychology; Algorithms; Antipsychotic Agents; Follow-Up Studies

Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven.To study whether 1-year outcome will be better in a health care sector with early detection (ED) of psychosis compared with sectors with no early detection (no-ED).A quasi-experimental study with ED in 2 experimental sectors and no-ED in 2 control sectors. ED was achieved through low-threshold ED teams and information campaigns about psychosis for the public, schools, and primary health care providers. The ED and no-ED health care areas offered an equivalent assessment and treatment program during the first year. Two hundred and eighty-one patients were included; 88% were reassessed after 1 year.The ED-area patients (N = 141) had a median duration of untreated psychosis of 5 weeks at baseline compared with 16 weeks for patients in the no-ED area (N = 140). Positive and general symptoms, global assessment of functioning, quality of life, time to remission, and course of psychosis at 1 year after the start of treatment were not different between ED and no-ED groups. Outcome was significantly better for the ED area for negative symptoms.The ED, no-ED differences at baseline become attenuated by 1 year but not the difference in negative symptoms, suggesting secondary prevention in this domain of psychopathology. However, this possibility requires further testing by follow-up and replication.